Radial forearm fasciocutaneous free flap as a solution in case of Noma.

The authors describe a case of Noma or Cancrum Oris, an oral gangrenous disease, features more frequently found in children from developing countries. The clinical features, its ethiopathogenesis, and its particular link with different geographic and economic areas of the world, its clinical evolution as well as surgical treatment are all discussed. Underlined is the functional and organic aspect of this disease, in particular the distortion of the face, which commonly involves the full thickness of the cheek skin and bone, mandibular ankylosis and craniofacial dismorphisms, and the modern approach in reconstructive microsurgery. The authors report a case of a patient affected by Noma, with a very evident left face dismorphism, where we found a brilliant solution using a left radial forearm fasciocutaneous free flap, appropriately shaped.

Neurophysiological evaluation with multimodality evoked potentials in craniostenosis and craniofacial stenosis.

Multimodality evoked potentials (somatosensory and acoustic) have been recorded before surgery in children selected for surgical treatment for different kinds of craniostenosis and craniofacial stenosis. Evoked potentials were found to be deranged on at least one recording in 50% of cases, suggesting a significant incidence of neurophysiological alterations in these patients. No correlation was found between evoked potentials' derangements and clinical status, radiological findings, or different kinds of craniostenosis; moreover, a significant correlation was found between neurophysiological alterations and the age of the children. These preliminary data might define the possible role of neurophysiological tests in the presurgical evaluation of craniostenosis and craniofacial stenosis.

A delayed complication with steel wire osteosynthesis.

We treated a 6-year-old child for hyperteleorbitism. We performed a facial bipartition steel wire osteosynthesis of the frontal bone. After 7 years we observed two episodes of pneumococcal meningitis, which were treated with intravenous antibiotic, resulting in a prompt recovery. The computed tomographic scan and nuclear magnetic resonance image showed the steel wire included in the frontal sinus and in contact with the dura mater. Removal of the wire and suture of the dura allowed prompt recovery.

[Osteomas of the jaws. A clinical and rehabilitative problem]. / Osteomi dei mascellari. Un problema clinico e riabilitativo.

The authors study, based on three cases of maxillary osteoma brought to their attention, evaluates the most suitable type of operation to perform, and the method with which to attention which to approach the problem of postoperative functional rehabilitation. This pathological condition is characterized by slow developments and the late appearance of symptoms deriving from the invasion of surrounding tissues. The chosen technique is surgery, involving the removal of the neoplasm. The benign nature of the neoplasm makes conservative surgery possible, including the partial removal of the neoplasm, in order to preserve the bone tissue indispensable for prosthetic rehabilitation. In cases in which the neoplasm spreads to surrounding tissues, in which more destructive surgery is required with an attendant loss of considerable portions of bone, we have used osteo-muscular pedicle flaps in combination with implantation techniques to obtain adequate functional and prosthetic rehabilitation.

[Implant-prosthetic rehabilitation in posttraumatic maxillomandibular tissue losses]. / Riabilitazione implanto-protesica nelle perdite di sostanza maxillo-mandibolari post-traumatiche.

Trauma in the maxillary-facial region can causes loss of mucous, dental and bone tissues, particularly in cases of ballistic trauma in which the explosive force disperses the affected tissues to some distance. This circumstance greatly complicates functional rehabilitation, a process requiring not only the construction of prostheses to replace the lost dental structures, but also the reconstruction of the mucous and bone tissues that will support the prostheses. Using methods involving the formation of pedicle bone grafts and the use of implantation techniques, it has been possible to guarantee a satisfactory functional rehabilitation, and in addition good results from the point of view of appearance have been obtained.

Facial bipartition in hypertelorism.

In our cases of hypertelorism we used two techniques. In some cases, we used Tessier's original technique (Tessier et al, 1967), and in others the modification suggested by Converse (Converse et al, 1970). In still others, we did not remove any part of the medial portion of the nose, that is, of the nasoethmoidal complex. We can say now, that in the cases operated on during ages of already completed development (14 to 15 years), the follow-up presented satisfactory, if not exceptional results, but in the cases operated on during the first years of life (2 to 10 years) investigation of the results obtained allowed us to make some important observations. In a high percentage of these cases we observed a relapse of the anatomical positions reached by operation. In the cases documented here, the long-term results were inadequate.

Have you checked all your breast implants?

Mammary prostheses were initially used to increase breast volume in patients with mammary hypoplasia or hypotrophy. Checking more than 200 patients from two to ten years after operation, favorable results were found mainly in patients with congenital hypoplasia. When prostheses were used in mammary hypotrophy following hypertrophy, results were unfavorable, though sometimes the patient herself was satisfied. We conclude that patients requiring implants must be accurately selected. Prostheses should be used only when we are certain that favorable results will last much longer than six months after operation.